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Meat, Fish, andColorectal Cancer Risk:
The European
ProspectiveInvestigation into
Cancer and Nutrition
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Introduction
It has been estimated that approximately 70% ofcolorectal cancer could be avoided by changes inlifestyle in Western countries.
To examine whether associations exist betweenintakes of red and processed meat, of poultry, andof fish and colorectal cancer risk, a large WesternEuropean population were prospectively followed
People who eat diets rich in meat also tend to eat
less fiber and less fish , and a statisticallysignificant inverse association between dietary fiberconsumption and colorectal cancer risk in thiscohort has been reported elsewhere
Therefore the risk of colorectal cancer associated
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SUBJECTS AND METHODS
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Study Cohort
EPIC is a prospective study designedto investigate the relationshipsamong diet, lifestyle, genetic and
environmental factors, and theincidence of cancer.
The cohort includes 366 521 women
and 153457 men, aged 35 70 yearsat enrollment (1992 and 1998),recruited from the general population
in 10 European countries
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Study cohort (facts inrelation to this analysis)
478 040 subjects were includedinthis analysis.
For this analysis, 22 432 cohortmembers were excluded due to theprevalent cancer at enrollment (otherthan nonmelanoma skin cancer)
10 208 members who were in thelowest and highest 1% of thedistribution of the ratio of reported
total energy intake to energy
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Dietary and LifestyleQuestionnaires
Diet over the 12 months beforeenrollment was measured between1992 and 1998 by country-specific
validated questionnaires.
Most centers adopted a self-administered dietary questionnaire of
88 to 266 food items (some of thequestionnaires was administrated ata personal interview).
For this analysis, meats were
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Identification of ColorectalCancer Case Patients
The follow-up was based onpopulation cancer registries,(exceptin France, Germany and Greece)
Mortality data were collected fromeither the cancer or mortalityregistries at the regional or national
level. Follow-up began at the date of
enrollment and ended at either the
date of diagnosis of colorectal
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Calibration of the DietaryData
A second dietary measurement wastaken from an 8% random sample ofthe cohort (36994 participants!)
using a very detailed computerized24-hour diet recall method tocalibrate dietarymeasurements
across countries and to correct forsystematic over- or underestimationof dietary intakes
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Results
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Results
A total of 478 040 participantscontributed 2 279 075 person-yearsin a mean follow-up of 4.8 years
During follow-up, 1329 participantswere diagnosed with colorectalcancer (95% were verified
histologically) Increasing red and processed
meat intake was statistically
significantly associated with
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Results
Intake of fish was statisticallysignificantly inversely associatedwith colorectal cancer risk (for
highest versus lowest intake HR =0.69, 95% CI = 0.54 to 0.88, P trend
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Results
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Results
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Discussion
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Discussion
This study found a consistentpositive association between highintake of red and processed meat
and colorectal cancer and an inverseassociation between high intake offish and colorectal cancer.
The mechanisms underlying theassociation between colorectalcancer risk and high intake of red
and processed meat are uncertain
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Discussion
Endogenous nitrosation that arisesfrom ingestion of heme-iron but notof inorganic iron or protein may
account for the increased riskassociated with red and processedmeat consumption
Heterocyclic amines (HCAs) andpolycyclic aromatic hydrocarbons(PAH) in diet may pose a potential
risk of cancer to humans
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Discussion
It has been suggested that processedmeat intake has a strongerassociation with colorectal cancer
than red meat intake. Thesefindings was confirmed by thisstudy
It could not be determined whetherone type of meats (processed or red)were more strongly associated was
colorectal-cancers than others
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Discussion
Endogenous N -nitrosation, arisingfrom ingestion of heme, may accountfor the increased risk of colorectal
cancer associated with highconsumption of red meat and thelack of association with intake of
poultry.
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Discussion
Results from animal and in vitrostudies indicate that n 3 fattyacids, especially the long-chain
polyunsaturated fatty acidseicosapentaenoic anddocosahexaenoic acids, which are
present in fatty cold-water fish andfish oils, inhibit carcinogenesis
This study was unable to distinguish
effect between fatty fish and other
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Study limitations
Dietary assessment methods
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Conclusion
The data generated from this studyconfirm that colorectal cancer riskis positively associated with high
consumption of red andprocessed meatand support aninverse association with fish
intake.